Incidence of sudden cardiac death among college athletes declined in recent years
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Key takeaways:
- The incidence of sudden cardiac death among college athletes decreased over past 20 years.
- Incidence of sudden cardiac death remains higher in men, Black athletes and those who play basketball.
PHILADELPHIA — The incidence of sudden cardiac death among National Collegiate Athletic Association athletes decreased over the past 2 decades, researchers reported at the American Heart Association Scientific Sessions.
Although overall incidence declined, the incidence of sudden cardiac death (SCD) “remains astronomically high” in certain subgroups, including men, Black athletes, and those who play basketball and football, Bradley J. Petek, MD, director of sports cardiology at Oregon Health & Science University in Portland, said during a presentation.
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Petek and colleagues conducted a new study to understand the incidence, causes and trends in SCD among NCAA athletes over time.
“We were hopeful that this [study] can help inform prevention policies, especially in light of many highly publicized sudden cardiac death events among young competitive athletes recently,” Petek said.
Incidence, trends over time
The researchers looked at athlete deaths from July 2002 to June 2022, identified using the NCAA resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database and insurance claims. An expert panel reviewed autopsy reports and medical history to adjudicate causes of SCD.
Of 1,102 total deaths among NCAA athletes, 143 SCD cases were identified. Among the SCDs, the mean age was 20 years; 82% were male; 59% were white and 37% were Black; 45% were Division I athletes; and the primary sports were football (30%) and basketball (25%).
The overall incidence of SCD was one in 63,682 athlete-years, according to the results.
However, the incidence of SCD was higher in certain groups. Petek reported that male athletes had a four times higher incidence than female athletes (1:43,348 vs. 1:164,504 athlete-years) and Black athletes had a three times higher incidence than white athletes (1:26,704 vs. 1:74,581 athlete-years).
The sports with the highest incidences of SCD were basketball (1:19,164 athlete-years) and football (1:31,743 athlete-years).
When the researchers evaluated incidence rates stratified by sex, race, NCAA division and sport, Division I white male basketball players and Division II Black female track and field athletes had the highest incidence rates of SCD (1:5,848 athlete-years and 1:24,942 athlete-years, respectively).
Over a 4-year college career, the incidence of SCD remained high among Division I Black and white male basketball players (> 1:2,000 athlete-years over 4-year career), according to the results.
When the researchers evaluated trends over time, they found that the overall incidence rate of SCD among NCAA athletes declined significantly by about 29% every 5 years in the 20-year study period (5-year incidence rate ratio [IRR] = 0.71), whereas there was no change in the incidence of non-CV deaths (5-year IRR = 0.98).
In other results, the most common postmortem examination finding was autopsy-negative sudden unexplained death (19.5%), followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%) and hypertrophic cardiomyopathy (12.7%). Eight cases of SCD were deemed attributable to myocarditis; none were attributed to COVID-19 during the study period. Two deaths were attributed to commotio cordis, which reportedly affected NFL player Damar Hamlin earlier in 2023. Exertional SCD was more common among those with coronary artery anomalies and arrhythmogenic cardiomyopathy.
The results were simultaneously published in Circulation.
‘Continual efforts ... are imperative’
The researchers noted several limitations of the current study, including the lack of a mandatory national reporting system for SCD and inability to compare SCD rates between athletes and nonathletes. Moreover, there were no data on resuscitated cardiac arrests or preparticipation CV screening.
Petek and colleagues said the mechanism underlying the decline in the overall incidence of SCD over the past 20 years is unknown, but the results of the study suggest that preventive strategies currently used in competitive athletes may be having a positive effect.
“Continual efforts to improve CPR training, [automated external defibrillator] access, emergency action planning and preparticipation CV screening are imperative,” Petek said during the presentation.
Reference:
- Petek BJ, et al. Circulation. 2023;doi:10.1161/CIRCULATIONAHA.123.065908.
Perspective
Back to TopAlan P. Jacobsen, MB, BCh, BAO and Lili A. Barouch, MD
This study provides updated data on causes of SCD among NCAA athletes.
The study reiterated several important findings seen in prior studies. First, SCD continues to represent a relatively small portion of sudden death in athletes, 13% in this study, with most deaths due to accidents. Second, autopsy-negative sudden unexplained death continues to be the most common finding on autopsy (19.5%), followed by idiopathic left ventricular hypertrophy/possible cardiomyopathy (16.9%), hypertrophic cardiomyopathy (12.7%) and coronary artery anomalies (8.5%). Third, the incidence of SCD was higher in Black individuals, higher in males, and highest in Division I basketball players, although notably, a recent statement from the American College of Cardiology Sports and Exercise Leadership Council discourages race or sport-specific differences in athlete screening.
New to this study was the finding that the incidence of SCD in NCAA athletes has declined over the past 20 years. This may be related to both preparticipation screening practices and an increase in the development and implementation of emergency action plans.
Preparticipation screening strategies vary widely by program, and while the inclusion of the use of an ECG as a screening tool remains dubious, many programs have begun including them since the COVID-19 pandemic. Screening for symptoms remains crucial as one-third of individuals who experience sudden cardiac arrest have warning signs prior to the event. It is encouraging to hear that legislation such as the Access to AEDs Act has been introduced in the U.S. Congress. This legislation would require the U.S. Department of Health and Human Services to award grants to local educational agencies and private elementary and secondary schools to work in partnership with a health care entity to establish, support and maintain basic life support training programs, emergency action plans and automated external defibrillators.
Finally, case identification continues to be an important challenge since no mandatory reporting system is present in the U.S. for athletes. In contrast, Danish law mandates that all emergency personnel enter a standardized electronic report at the scene of a cardiac arrest capturing all sports-related SCDs in the Danish Cardiac Arrest Registry. Similarly, Italian law requires the report of sudden cardiac arrests in all registered Italian athletes. The U.S. military also tracks all deaths through a mandatory reporting system. In the current study, four separate independent databases and search strategies aimed to capture as many events as possible; however, the variation in event rates identified by each method reaffirms the need for a mandatory reporting system in the U.S.
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Petek B. Featured Science: Exercise is life (and death) – Approaches in athletes, arrhythmias and heart failure. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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